How Much Will a Pacemaker Cost Without Medicare?

While most people have heard of a pacemaker, many aren’t sure what exactly it does. In the world of durable medical equipment, it is one of the most common. And there are a variety of health conditions that require a pacemaker. An artificial cardiac pacemaker is a device implanted in the heart that generates small electrical impulses into chambers of the heart. These signals head to either the upper atria or lower ventricles, causing them to contract and pump blood. The main goal of the pacemaker is to regulate the electrical function of the heart by maintaining a regular heart rate.

Why a Pacemaker?

As previously mentioned, a pacemaker is designed to help the heart maintain a normal rate. Many reasons exist for needing a pacemaker. Sometimes, the natural heartrate isn’t quite fast enough. Other times, something is blocking the heart’s electrical system, hindering signals from reaching their destination.

How do Pacemakers Work?

Today, pacemakers can be programmed externally. This allows a cardiologist to make adjustments to find the optimal pacing modes for each patient. Most pacemakers on the market today are on demand, meaning they respond to the needs of the circulatory system. There are models that send out a pre-determined rate of impulses, though. You will find two main types of pacemakers, as well. One, an implantable cardioverter-defibrillator, is both a pacemaker and a defibrillator in one device. Biventricular pacemakers, on the other hand, have more than one electrode to stimulate various places in the lower heart chambers to ensure they are working together.

How are Pacemakers Implanted?

Thankfully, a pacemaker implantation is minimally invasive surgery performed by qualified surgeons. Normally, patients have a hospital stay anywhere from 24 to 48 hours. During the procedure, a surgeon must attach the probes to the appropriate area of the heart in the desired chamber, and then attach those connections to the pulse generator. This generator is then implanted under the skin or under the pectoral muscle, depending on the doctor and patient. Because the surgery is minimally invasive, it is usually performed under local anesthesia in an electrophysiology room, which is like an operating room.

The interventionist arrhythmologist, the one who implants the device, uses fluoroscopic control, which uses X-rays to create real-time video footage of the procedure. After the procedure, the patient usually stays in the hospital for at least one night. Cardiologists want to monitor the heartrate and ensure the pacemaker is working correctly. After 24 hours, an X-ray of the chest will make sure the pacemaker and wires are still in place and functional, and an echocardiogram checks on the heart.

Extra Costs

Many of the costs associated with a pacemaker implantation vary greatly, because there is not one single procedure. For example, sometimes the procedure is performed on an outpatient basis, while other times as an inpatient procedure. Furthermore, the average length of hospital stay varies greatly. A single night in a hospital can cost upwards of $25,000. So, a two night stay will have a drastically different price tag than a six night. After the device is implanted, there are more costs to consider, as well. Many cardiologists require quarterly checks. Each visit can cost around $200. These visits are to monitor the efficiency of the pacemaker and make sure the patient and heart are healthy.

Beyond that, pacemaker batteries are designed to last for only seven or eight years, sometimes less. Each pacemaker battery replacement could cost around $5,000. Different insurances cover this replacement at different rates, but you are responsible for some of it. Medicare Part B covers around 80%, usually. Finally, any prescription drugs required by individual patients is an expense to consider.

Cost of the Device and Procedure

Because there isn’t just one type of pacemaker or hospital that implants them, the cost can vary anywhere between about $20,000 and $100,000, without insurance. This range is only for the pacemaker and the hospital stay and doesn’t include a heart-assist pacemaker. Of course, insurance will pay out different amounts, but that is an entirely different subject. In Wisconsin, for example, the average price for a defibrillator and heart-assist implant will run a patient around $97,000. However, in Ohio, a patient would pay around $20,000 for the actual device along with anesthesia, the surgery, and a five-day hospital stay.

If you live in the Western part of the United States, the overall cost of a pacemaker implant, including the device and procedure, runs about $30,000. HealthGrades is a great source to get more information about local costs. One thing is generally clear, however, that Medicare covers pacemakers at a higher rate than many private insurances. On average, a patient with Medicare can expect to pay around $2,800 for a pacemaker while patients on private insurance will be responsible for about $4,500.